hort reached a gestational age of 34 weeks. There were no intrauterinefetal deaths in either group. There were no significant differences inbirthweight or neonatal morbidity.CONCLUSION: Continuous fetal monitoring did not improve neonatalsurvival or perinatal morbidity when compared with inpatient inter-mittent fetal monitoring.

692 Improved perinatal outcomeswith fetal monitoring in GhanaFrank Anderson1, Joseph Seffah2, JocelynnOwusu1, Mark Chames3, Jerry Coleman4

1University of Michigan, Obstetrics and Gynecology, Ann Arbor, MI,2University of Ghana, OBGYN, Accra, 3University of Michigan MedicalCenter, Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Ann Arbor, MI, 4University of Ghana,Obstetrics and Gynecology, Accra, GhanaOBJECTIVE: To evaluate the effects of NST on perinatal outcomes inhypertensive disease in Ghana, where electronic fetal monitoring isnot routine.STUDY DESIGN: A modified fetal assessment center was established at amajor teaching hospital in June 2010. From May 2010 to July 2011,316 women with preeclampsia or PIH were followed from admissionto delivery. PIH was defined as Systolic blood pressure (SBP) �140mmHg or diastolic blood pressure (DBP) �90 mmHg; preeclampsiaincluded the presence of proteinuria �0.3 grams. Exposure to NSTand fetal outcomes were recorded. Prevalence of of Apgar5�7, unex-pected stillbirth, and early neonatal mortality were compared for themonitored an unmonitored group. An unexpected stillbirth was de-fined as a fetus admitted to the hospital live but died in utero.RESULTS: Patients in the unmonitored group received routine carewhich consisted of ausculation of the fetal heart rate in the antepartumand intrapartum period. Monitored patients received antepartummonitoring. Intrapartum monitoring was per routine. Preliminaryresults are from 164 unmonitored and 154 monitored patients. Therewas no significant differences in in gravidity (3.07�/�2.20 vs. 3.16�/�1.85), Parity (1.46�/� 1.57 vs. 1.49�/�1.50), SBP (156�/�22 vs.153�/�21), DBP(101�/�18 vs. 98�/� 15). Age (30�/�6.0 vs.32.8�/�5.6) and gestational age (36.9�/�3.7 vs. 35.6�/�3.3) werestatistically different between the two groups (p�0.01). PIH cases hadno difference in apgar5 �7 (5.7% vs. 4.5%; p�0.54); while 21.6% ofinfants of unmonitored preeclamptic mothers had Apgar5�7, cf 5.1%in the monitored group (p�0.01). Unexpected stillbirth occurred in9.2% of unmonitored preeclamptic cases and 3.6% of monitoredcases (p�0.11). Perinatal death occurred in 10% of the unmonitoredpreeclamptic group and 2.5% of the monitored preeclamptic group(p�0.05).CONCLUSION: The introduction of antepartum testing for women withPreeclampsia might significantly reduce perinatal mortaliy in low re-source settings and should be adapted to low resource settings to de-crease mortality.

693 The effects of maternal caffeine intakeon fetal heart rate and uterine contractionsAndrea L. Tranquilli1, Giorgia Buscicchio1, MariangelaPiemontese1, Lucia Gentilucci1, Filippo Ferretti1

1Universita Politecnica Marche, Clinical Sciences, Ancona, ItalyOBJECTIVE: To analyze the effects of maternal caffeine ingestion onfetal heart rate (FHR) and uterine contractions.STUDY DESIGN: Fifty pregnant women with uncomplicated gestation,matched for age and parity, underwent computerized FHR recordingbefore and after the consumption of 80 mg caffeine (one cup of“short” coffee). Computerized cardiotocography parameters were ex-pressed as mean and SD. The differences were tested for statisticalsignificance using the paired t-test, with significance at p�0.05.RESULTS: The number of uterine contractions, the number of smalland large accelerations (10 and 15 beats per minute for 15 seconds),the duration of episodes of high variation and the short-term FHR

variation were significantly higher (p�0.001) after maternal coffeeintake.CONCLUSION: Our results suggest that maternal intake of caffeine has astimulating action on fetal reactivity. This finding is likely due to thepharmacological action of theobromine, a methylxanthine present incoffee. The correlation between maternal caffeine intake and in-creased uterine contractions is likely due to the effect of caffeine on theuterine muscle.

694 Perinatal outcome of singleton pregnancies complicatedby oligohydramnios prior to 26 weeks gestationJulia Unterscheider1, Rebecca Moore2, Farkhanda Mohammad3,Naomi McCallion4, Fionnuala Breathnach5

1Royal College of Surgeons in Ireland, Obstetrics & Gynecology, Dublin,Ireland, 2Rotunda Hospital, Obstetrics & Gynecology, Dublin, Ireland,3Rotunda Hospital, Pediatrics, Dublin, Ireland, 4Rotunda Hospital,Pediatrics, Dublin, Ireland, 5Royal College of Surgeons inIreland, Obstetrics and Gynaecology, Dublin, IrelandOBJECTIVE: Mid trimester oligohydramnios is associated with poorperinatal outcome and may prompt termination of pregnancy. Theobjective of this study was to evaluate underlying causes of mid tri-mester oligohydramnios and to describe pregnancy outcomes.STUDY DESIGN: This retrospective cohort study was carried out over a6-year period (2005-2010) in a tertiary referral centre in Dublin, asetting in which pregnancy termination is not locally available.RESULTS: Our study describes perinatal outcomes of 86 consecutivesingleton pregnancies complicated by oligohydramnios prior to 26weeks gestation due to (i) preterm rupture of membranes (PPROM),(ii) fetal renal/ structural abnormalities or (iii) uteroplacental insuf-ficiency (UPI) as outlined in table 1. Renal tract abnormalities ac-counted for the majority of cases (38%; n�33) and were almost uni-versally associated with poor perinatal outcome. 29 cases wereattributed to PPROM; 2 patients underwent pregnancy termination.Of the 27 ongoing pregnancies, spontaneous fetal loss ensued in 2cases shortly after diagnosis (7%), there were 3 stillbirths (11%), 10neonatal deaths (37%) and 12 surviving infants (45%). The survivorshad a mean birthweight of 2,077grams and were delivered between 25and 37 weeks gestation. The mean gestational age of PPROM diagno-sis for survivors was significantly later (19.8 weeks) than for neonateswho died after birth (17.4 weeks). 20 cases were due to early onsetplacental failure; in this group, 40% (n�8) were associated with crit-ically abnormal Dopplers with only 1 surviving neonate. The remain-ing 12 cases were diagnosed between 18 and 26 weeks gestation andresulted in 7 stillbirths (58%), 1 neonatal death (8%) and 4 survivinginfants (33%). These infants were born between 35 and 38 weeksgestation and had a mean birthweight of 1,903 grams.CONCLUSION: The above natural history outcome data provides usefulinformation for health professionals charged with prenatal counsel-ling. Oligohydramnios prior to 26 weeks gestation is not associatedwith a universally poor outcome, but perinatal survival is driven bythe underlying etiology.

www.AJOG.org Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical-Disease Poster Session V

Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology S309